REQUEST FORM for Auto Auction Service

Please send us Reference No. of car you want to buy from Auto Auction List. So, we will confirm the car is available or not, and we will inform you the detail of car to you by e-mail or phone after checking it immediately. First of all, please fill out this form and push "SEND"button accordingly. Advicing of your max.bit price in advance would be very appreciated. We expect for the balance within 5days. So, please send by email, or fax, the date of remittance and from which Bank.

*	*	*	required ( * )
1	Your name		*
2	Company name		*
3	You are ......	Please select Car importer Car dealer Private importer (Re-sell bases) Individual person (Personal use)	*
4	Address		*
5	State		*
6	Country		*
7	e-mail	* no space at left side	*
8	e-mail again (confirm)	* no space at left side	*
9	Tel number		*
10	Fax number		*
11	URL		*
12	Mobilephone number		*
*	*	*	*
13	Reference Number		*
14	Your Max. bit price		*
15	Shipping terms	Please select FOB Japan CIF destination C&F destination	*
16	Currency	Please select US dollars Japanese yen	*
17	Message (If you have)		*
18	Payment	Could you send balance of money to our bank accout within 5days? when success to bid YES NO

Copyright ( C ) /2006 All right Reserved

Fullhouse International Limited operates with Permission from Gunma Public Safety Commission.
Reg. No. 421110199800